Contributions of the institutions for the nursing professionalization: integrative review (2010-2020) in the light of freidsonian conceptions

ABSTRACT Objective: To analyze the contributions of the Brazilian Nursing Association and the Federal and Regional Nursing Councils in the literature for the professionalization of nursing in the light of Eliot Freidson’s theoretical conceptions. Methods: Integrative review of the literature, of socio-professional historical interest, carried out from June to November 2021, through the question: How did professional associations contribute to the professionalization of Brazilian nursing according to the literature from 2010 to 2020? The evidence were organized in a synoptic table, which allowed the construction of a conceptual map. Results: In the 23 selected studies, the professional associations presented scientific, social and political contributions, which shape the professional field of nursing, enabling knowledge/expertise, autonomy and self-regulation. Final considerations: The efforts of these institutions reaffirm nursing as an academic and consulting profession, capable of exerting control over the essence of nursing work. They strive to consolidate nursing as a legitimate professional field of health in Brazil.


INTRODUCTION
In the process of professionalization of Brazilian nursing, Working class institutions cooperated for the constitution and consolidation of the profession, no longer as an occupation, since recognition as a professional category involves struggles and achievements of leaders in different economic, social and political contexts, contributing to the formation of professional identity (1) .
In the scope of the sociology of professions, the American theorist Eliot Freidson states that a profession is distinguished from an occupation by the control it exerts over work (2) . The central idea of the sociologist's proposal is that the most productive method for analyzing professions is based on focusing on the way in which they achieve or lose control over the terms, conditions and content of the work (2) .
Furthermore, Freidson characterizes a profession by three aspects: knowledge/expertise, self-regulation and autonomy. Professions share a specialized body of knowledge and qualifications which have jurisdiction, whose credentialing occurs through institutionalization in schools and universities, and occupational control of practice in the labor market, by requiring credentials to perform licensed and state-backed actions (3) .
Credentialism is consolidated in the specific knowledge/expertise of the profession, indispensable to legitimize the achievement of autonomy (1) . It is through autonomy that the profession controls what is its own (2) . When considering these aspects, it is noted that class institutions become bases for profession, discipline and work. They also support professionalism, a set of characteristics specific to professionals (2) ; and professionalization, characterized by interdependent elements, specialized work based on specific knowledge and ethics, when applying and performing professionally (1) .
Class institutions act effectively in favor of the category and society when they defend a political project of training and qualification that meets the interests of professionals in this class and social demands. They promote the dissemination of knowledge about and for the profession, representing these professionals in the different fields of activity in which they are inserted (4) .
In Brazil, the vanguard of the organization of nursing and the representation of the categories took place in 1926, with the graduation of the pioneer group of the Anna Nery School of Nursing. Created on August 12 of that year, the National Association of Graduate Nurses (NAGN), currently the Brazilian Nursing Association (ABEn), promoted the improvement of professionals and training programs, with a commitment to growing and consolidating scientific development, social and political aspects of nursing, and its history is permeated by the articulation with other organizations, based on ethical principles and on the attributions that were incumbent upon them (5)(6)(7) .
ABEn started other nursing organizations and boosted their development in Brazil (8) . Thus, the creation of the Federal (Cofen) and Regional Nursing Councils (Coren) has an intrinsic relationship with the history of ABEn. Many efforts were made to implement the creation of the body that would supervise the practice of nursing professionals. The first efforts took place in the period from 1943 to 1947, but only on July 12, 1973, law 5905 was enacted, which provided for the creation of the Cofen/Coren System, an autarchy linked to the Ministry of Labor and Social Security, which has the Disciplinary function of the professional practice of nursing (8)(9) .
After Cofen and Coren were installed, the discussions on the new Professional Practice Law project, which would replace Law 2604/1955, stood out. Thus, law 7498/1986 was approved, regulated by decree 94406/1987 (10)(11) . Among other Cofen actions, we mention the approval, through Cofen resolution 564/2017, of the new Code of Ethics for Nursing Professionals. In this process, the Cofen Code of Nursing Deontology, from 1976, and the Code of Ethics of Nursing Professionals, from 1993, reformulated in 2000 and 2007 (12) were considered.
In this context, the design of the contributions of class institutions to the professionalization of Brazilian nursing makes it possible to understand their influence and relevance to the conformation of nursing as a profession and field of scientific knowledge in health. It also reinforces, through historical facts, the importance of associative life for the construction and strengthening of professional identity.

OBJECTIVE
To analyze the contributions of the Brazilian Nursing Association and the Federal and Regional Nursing Councils in the literature for the professionalization of nursing in the light of Eliot Freidson's theoretical conceptions

METHODS
Integrative literature review, of socio-professional historical interest for nursing, carried out through the following steps: formulation of the problem and the research question; literature search and application of eligibility criteria for the study; selection of articles; reading and extracting relevant data; analysis and interpretation of data; organization of data into categories and presentation of the synthesis of the knowledge produced (13) . The bibliographic survey, data collection and analysis took place from June 4 to November 29, 2021. The study adopted the recommendations of The PRISMA 2020 Statement: an Updated Guideline for Reporting Systematic Reviews (PRISMA) (14) .
To select the studies, the research question was formulated based on the PICo (15) : strategy: class institutions constituted the problem (P); contributions to professionalization, the phenomenon of interest (I); and nursing, the context (Co). Thus, the guiding question was elaborated: How did class institutions contribute to the professionalization of Brazilian nursing according to the literature from 2010 to 2020? This strategy enabled the identification of controlled and uncontrolled descriptors, which were selected by consulting the terms in the Descriptors in Health Sciences (DeCS), Medical Subject Headings (MeSH) and List of Headings of the Cinahl Information Systems.
The bibliographic search was carried out by consulting the electronic databases Cumulative Index to Nursing and Allied Health Literature (Cinahl), Digital Nursing Library (BDENF), Latin American and Caribbean Literature in Health Sciences (Lilacs), Medical Literature Analysis and Retrieval System online (MEDLINE® via PubMed®) and Web of Science. The Boolean operators "OR" and "AND" were used to combine the search terms and intensify the reach of the number of articles that answered the research question, which generated the search strategies (Chart 1) for each of the consulted bases.
Original studies were included, published in English, Portuguese or Spanish, from January 2010 to December 2020. 2010 was established as the initial year due to the creation of the Scientific Department of Nursing History (DHE) by National ABEn. The DHE is linked to the Center for Studies and Research in Nursing (CEPEn), which has the function of encouraging the development and dissemination of historical research in nursing. The year 2020 was adopted as the final cut, as it has historically impacted society and the profession, professionalism and professionalization of nursing, considering the 2019 coronavirus disease (Covid- 19) pandemic. In addition, the World Health Organization (WHO) established this year as the International Year of Nursing and Midwifery (16) . Dissertations and theses, case studies, biographies and experience reports were excluded. Also, the articles captured in duplicate were considered only once, keeping them in the specific bases for nursing, followed by the multidisciplinary ones.
It should be noted that two independent reviewers performed the identification, screening, eligibility and inclusion steps. The EndNote reference manager was used to set up the database, identify and eliminate duplicates. Then, the resulting database was exported to the Rayyan Qatar Computing Research Institute (Rayyan QCRI) (17) , for screening, eligibility and inclusion of studies. The Rayyan QCRI allows the evaluation of studies with the blinding of the auxiliary reviewer, which favors reliability in the selection of information and methodological precision (17) . In the eligibility stage, there was disagreement in 16 studies, which were sent to a third reviewer to issue an opinion on the inclusion or exclusion of the article.
The form adapted from the Occupational Health Nursing Network (RedENSO) (18) instrument was used to extract and record the pertinent information. The evidence of the selected articles was presented in a synoptic table, which enabled the construction of a conceptual map, in order to favor the understanding and discussion of the contributions of class institutions in the professional conformation of nursing. The conceptual map was developed by the American Joseph D. Novak, in the 1970s, and is characterized by the hierarchical or schematic structuring of concepts immersed in a network of propositions, which favors the construction of knowledge. It can be considered as a visual representation to share meanings (19) .
For that, we used the free concept mapping software Cmap Tools 6.03 for Windows, due to the ease of handling and construction of interactive diagrams, whose completion occurred with the use of PowerPoint. The conceptual map construct was based on the concepts of knowledge, autonomy and self-regulation, aspects of a profession by Eliot Freidson, placed at the center of
Each article was evaluated to identify the Level of Evidence (LE), according to the concepts of Melnyk and Fineout-Overholt, classified into six levels: I for systematic review, meta-analysis or studies from guidelines based on randomized controlled clinical trials; II for at least one randomized controlled clinical trial; III for controlled studies without randomization; IV for case-control or cohort studies, as long as they are well designed; V for systematic review of qualitative and descriptive studies; VI for a single qualitative or descriptive study; VII for the opinion of authorities and/or expert committee reports (43) . Publications were classified in Level of Evidence VI, resulting from a descriptive or qualitative study.
These evidence were schematized in a conceptual map ( Figure  2), in order to present how the different contributions of the ABEn and Cofen/Coren class institutions shape the professional field of nursing, according to the concepts of the theoretical Eliot Freidson.   Since the beginning, it has been concerned with issues related to teaching, the dissemination of the profession, scientific development, the creation of a staff of nurses in the organizational structure of the State and professional development.

Socio-historical study
Credentialism was inherent in the path of the precursors of the profession in the development of Coren-SC. The creation of Coren-SC contributes to the legitimacy and status of the profession.

Coren
The creation of the Regional Nursing Council of Piaui (37) / 2016/ Enfermagem em Foco

Social-historical study
The Special Board carried out the registration of professionals and the election of the first board, which had to clarify professionals about the need for professional registration. VI Coren Regional Nursing Council of Santa Catarina (1975Catarina ( -1986: importance for the profession (38) /2015/ Texto Contexto Enferm

Social-historical study
The performance of Coren-SC, from 1975 to 1986, was permeated by difficulties in the adherence of nursing professionals to the purposes of a disciplining and inspection body, which had an impact on the delay of inspection activities.

Coren
Birthplace of the Santa Catarina Regional Nursing Council (1970s) (

DISCUSSION
Class institutions aim and mobilize the strengthening of nursing (1) , considering the criteria that distinguish a profession from an occupation, namely: own knowledge and skills, autonomy and self-regulation and especially reliable members (1,3) . In this context, it is clear that the publications from 2010 to 2020 reinforce the contributions of ABEn and the Cofen/Coren system in professional conformation. The grouping of scientific capital, as proposed by the DHE, promotes and preserves the history of nursing in different contexts, contributing to the dissemination of knowledge that permeates the historical process of the profession and its professionalization.
The construction of nursing as a science and a profession result from the constitution of its own field of knowledge and a scientific framework to support and sustain professional practice. This constitution is permeated by the trajectory of different subjects in different contexts, whose appreciation of history, encouraged by the DHE, contributes to the construction of professional identity. Historically, ABEn is the principle behind the design and production of this knowledge for nursing, with initiatives that involve issues related to nursing education and training, scientific research and its propagation among professionals (20,24,(26)(27)(28)(29)(30)31,42) .
Concerning nursing education and training, in the 1940s, ABEn created the project that subsidized law 775/1949 and institutionalized nursing education in Brazil. At the end of the 1960s, she discussed the implications of the University Reform for the training of nurses (27,29,42) . These facts show efforts to establish and dominate ownership over a specific field of knowledge, the acquisition of which needs to be taught and perfected, through the structuring of a curriculum that includes the know-how of the profession.
In the context of expanding nursing schools in Brazil and in the proposal to form another affiliated association (in the 1940s) (23,32) , ABEn, in the 1946 Statute, created state and regional sections (21)(22)(23)25,30,33) . The initiative to form these sections reinforces not only the maintenance of the Brazilian nursing unit, but also the expansion and mastery of decision-making spaces in nursing education and training, being present in the most diverse Brazilian regions. Maintaining the nursing unit was important for its strengthening, since ABEn was the only existing entity with the power to represent Brazilian nursing until the creation of Cofen (44) .
Still in the field of education, the 1990s registered two important historical moments for nursing with the involvement of ABEn: the participation of the Education Boards, providing subsidies to the Federal Council of Education, for the approval of the new minimum nursing curriculum, in 1994. In the context of the educational reform that defines the approval of the most important Brazilian law, with regard to education, the Law of Directives and Bases of National Education (LDB), in 1996, in which ABEn undertook strategic efforts in struggles related to to political-expansionist, political-legal and political-organizational guidelines (31) . In the midst of this process, ABEn held the National Seminars on Guidelines for Nursing Education (SENADEns) (20,29,31) , which discussed and encouraged the elaboration and approval of the National Curriculum Guidelines, approved at the turn of the 21st century, in 2001. From then on, ABEn turned to its own implementation and consolidation (29) .
The process of professionalization of an occupation mainly involves the political processes which occupations obtain the State to grant them the exclusive right to perform certain tasks, to recruit and educate members, to delimit the field of action in relation to other occupations and to define in which the work will consist. The State plays a decisive role in the success of a profession, formally granting it the right to monopolize professional practice in the labor market, inhibiting unfair competition and imposing boundaries of competence (45) .
ABEn, working together with the Ministry of Education and the Federal Council of Education in the context of the Brazilian educational reform, plays a leading role in directing and reinforcing the formation of expertise necessary for the performance of nursing. Once directed to the production of knowledge and the domain of qualification, there is control of work and ownership of a body of formal knowledge learned in higher education institutions, in other words: the knowledge and qualification necessary for the exercise of the work for the profession.
Other efforts by ABEn to appropriate the knowledge necessary for nursing and the improvement of this knowledge are recognized, such as the movements for the development of research (27) . In this regard, the dissemination of knowledge produced through the publication of the Revista Brasileira de Enfermagem (REBEn) (20,27,(29)(30)42) , created in 1932 under the name Annaes de Enfermagem, stands out. It is configured as a space for the formation of the scientific community, as well as for the structuring of the scientific field. Therefore, it reveals the scientific thinking of Brazilian nursing and ABEn's associative life policy (29) . REBEn is the materialization of the desire to solidify nursing science knowledge for the collective.
The development of scientific activities is also noteworthy as shown in the conceptual map. It begins with the production itself of the first research on the numerical and qualitative situation of Brazilian nursing (27,29,42) , which permeates the organization of spaces for discussion and scientific dissemination of nursing in the national and international scenario (20,24,(26)(27)(28)(29)31,42) and immortalizes memories, through the preservation of the material and symbolic heritage of nursing. This is the Brazilian Nursing Memory Center, a place where a dense mass of documents accumulated over time is kept, which reveals the preservation of the memory of those who make the association (28) . The exchange of scientific knowledge and nursing practices is also provided by the agenda of the Brazilian Nursing Week, a heritage of ABEn (20,29,42) .
Professional knowledge establishes the authority to have control over one's work, as described by the sociologist Freidson: "authority of imputed expertise", that is, professionalization requires the establishment of an authority of expertise, a professional knowledge that is so complex and incomprehensible by lay people, which lends relevance to the work, as well as the recognition of the superiority of knowledge and competence, guaranteeing technical autonomy (45) . This is the case of the specific themes discussed at the Brazilian Nursing Congresses (CBEn). Among these, psychiatric nursing is mentioned, which addresses aspects of the field of practice, professional qualification, as well as conceptual bases for the teaching of psychiatric Nursing (24) .
It is observed that ABEn contributes to the scientific knowledge of nursing, in order to favor the development of competences for the profession. Thus, it makes it possible to ensure that, in addition to increasing expertise, these professionals have autonomy in their professional practice.
Thus, nursing autonomy is legitimized by the implementation of theories, as well as care based on the systematization of nursing care (46) . It is understood that nursing is a characteristically autonomous profession, capable of independently exercising its own work in different scenarios. Its object of care is related to human responses and processes of adaptation to situations of health problems, not just compliance with the prescriptions of other professionals who make up the multidisciplinary team.
It is up to nurses to achieve this autonomy, supported by their own knowledge and recognition of the positive value of the profession for society (3) . Professional autonomy is not obtained by the profession, but results from a political and social process of legal concession, which is conferred on the profession by society (45) . From this perspective, in many of the immense care voids in the Brazilian territory, nursing is present in society. It autonomously performs the care, aiming at the promotion, protection and recovery of the population's health. The growth of entrepreneurship in nursing and the increase in nursing offices are also emphasized, which reaffirms the autonomy of this profession. Therefore, it cannot be detached from social transformations to reinforce its autonomy and necessity.
In this context, ABEn engages in the most different movements of society. It participates in the fight in defense of the Unified Health System -Sistema Único de Saúde (SUS), of quality health care for citizens, of laws and public social and health policies, of the consolidation of nursing as a social practice. It is present in municipal and state councils and health conferences (20,26) .
In addition to social movements, ABEn maintains national and international relations to represent Brazilian nursing. Thus, it participates in the International Council of Nurses (ICN), the Asociación Latinoamericana de Escuelas y Facultades de Enfermería (Aladefe) and the Federación Panamericana de Profissionales de Enfermería (Feppen) (29) . It is believed that the articulation of ABEn with other institutions in the world of nursing makes the mission for Brazilian nursing even more expressive. The involvement, under the responsibility of the International Council of Nurses, in the creation of the International Classification of Nursing Practices (ICNP®) and the International Classification of Nursing Practices in Collective Health (CIPESC®) (29) , both instruments aimed at support the systematization of nursing care and, consequently, the autonomy of the profession.
In order to have control over its own work, in addition to investing in knowledge and technical-scientific improvement, ABEn fights to obtain appreciation and regulation of the profession, which has already resulted in laws 2604 of 1955 (42) and 3780 of 1960, which include the nurse at the technical-scientific level (42) . In addition, there are efforts to build a Nurse staff (25) , hire a nursing professional to replace people without specific training, initiatives to prohibit the misuse of the nursing title (30) and discussion of private actions for nurses (33) . These facts show the concern to regulate and regulate the exercise of the profession by those who possess the necessary expertise.
ABEn actively participated in the formation of the legal provisions of the profession, with the creation of a body that self-regulated the practice of nursing and, consequently, protected members and society by guaranteeing the aptitude of those who performed it (20,29,42) . Cofen/Corens were created, which granted legitimacy and autonomy to the exercise and specific practice of the profession, in addition to valuing assistance based on ethical and moral principles (39)(40)42) .
Thus, contributions from Corens, such as Minas Gerais, where there was an effort to develop the Technical Chamber of Obstetrics (CTO), in 2007, aim to guarantee autonomy. The creation and mobilization of the CTO has a social and political impact on the valorization of obstetric nursing by bringing professional recognition of obstetric nurses, not only in the service in which they work, but also for the whole society (34) .
Recognition comes from the autonomy necessary to achieve professional status. The reach and maintenance of this status depends on the protection of society, which is convinced of the special value of work (3) . Thus, the councils help society to trust and feel secure with the work offered. Thus, they safeguard and protect the members and the population. In this context, the current movements of Cofen/Corens and ABEn are emphasized to ensure dignified conditions for professional practice, having as the agenda for discussions and actions the law of the minimum wage for nursing and the 30-hour working day. In addition, the movements seek to guarantee quality training and committed to the development of professional skills, by rejecting undergraduate nursing courses in the distance modality.
The protection granted to members and the population results from the profession's ability to carry out self-regulation, understood as control of the exercise of expertise carried out by professional associations that hold legal and formal authority granted by the State (2) . The institution of this inspection body was important for the nursing profession, as ABEn has a representative role, but does not have the legal rights to carry out professional registration (44) .
Therefore, through the Cofen/Corens system, nursing obtains control of a specific work domain, necessary to achieve autonomy (2) . In addition, it guarantees power over work, in addition to organizing, regulating and ensuring the quality of the practice of the profession, through professional registration (35,(37)(38)(39)41) , legislation (36,41) and inspection activities (39)(40)42) . These actions allow it to be practiced by those who have specialized, qualified knowledge and qualifications granted for the exercise, that is, the credential, defending it regarding the quality of care and ethical standards, which favors visibility and recognition (36)(37)(38)(39) .
Cofen and Corens work in the development of this professional class at a local and regional level (34)(35)(36)(37)(38)(39)(40)(41) . Thus, the existence of an institution that regulates the exercise is essential for the credentialism and self-affirmation of the profession.
The achievements historically built by nursing class institutions become even more evident in the year 2020, considering the pandemic context of Covid-19. In the midst of the health crisis, nursing once again reaffirms its protagonism, professional practice through knowledge/expertise, self-regulation and autonomy. Professionalism is highlighted in the health scenario and clearly confirms the social need for nursing.

Limitations of the study
In this review, the searches were carried out in databases directed to the area of health and nursing. However, the lack of research in databases in the area of history and cross-search may not have covered all articles on the subject. In addition, the study did not cover the analysis of historical facts implemented by all sections of ABEn, which could also represent a contribution to the conformation of specific or specific knowledge of nursing in a certain region, considering the plurality of the population and Brazilian regions.

Contributions to the area of nursing and teaching the history of nursing
Class institutions must be strengthened by knowledge and recognition of the contribution to the credentialism of nursing as a profession. From this perspective, many achievements permeate ABEn and Cofen/Coren, and it is important to socialize them. The findings can serve as an incentive to carry out studies that individually address regional nursing sections. Thus, they will highlight, deepen the specificities and expand the knowledge and expertise of each region, so that the actions result in the valorization and professional recognition of autonomy, considering that Brazil is a continental country.
Furthermore, making these contributions visible is a relevant agenda to awaken nursing professionals to the importance of associative life, to increase the status quo and understanding of nursing as a practice and social need. The institutions provide an opportunity to expand the debates about the monitoring of professionals in the transformations of the country's political and social processes, mainly in the guarantee of universal rights to health.

FINAL CONSIDERATIONS
The studies included in this review, supported by Fredsonian conceptions, revealed that the nursing institutions Brazilian Nursing Association and Federal and Regional Councils of Nursing contribute to the professionalization process, supported by their own knowledge and the demarcation of expertise, linked to institutionalization, autonomy and self-regulation.
The Brazilian Nursing Association was categorical in the struggles and actions that configure the development of expertise through acting in nursing education/education, in the increment of research and in the dissemination of this knowledge through the various forms of socialization. The conformation of this expertise strengthens the delimitation of the areas of necessary competences and skills, differentiating them from other professions. Through the efforts of the Brazilian Nursing Association, the council was created. Thus, there is the emergence of a body that regulates and supervises the exercise of the profession and its self-regulation, supporting the credentials for professional autonomy.
It is concluded that the continuous efforts undertaken by these class institutions reverberate in the year 2020 when nursing, in the international year by the World Health Organization, stands out in the leading role in facing the pandemic. It shows itself with technical, scientific, ethical, humanistic and professional competence, confirming its function as an academic and consulting profession, whose practice for the community is based on scientific knowledge produced by peers. Thus, nursing is reinforced as a qualified profession, capable of exercising control over its own work, autonomously. Thus, in different historical contexts, these institutions legitimize Nursing as a health profession in Brazil.

COLLABORATIONS
Maia NMFS, Silva FAA and Araújo AAC contributed to the conception or design of the study/research. Maia NMFS, Araújo AAC, Santos FBO and Aperibense PGGS contributed to the analysis and/or interpretation of the data. Santos AMR, Santos FBO and Aperibense PGGS contributed to the final review with critical and intellectual participation in the manuscript.